Comparison of the inflammatory response between miniaturized and standard CPB circuits in aortic valve surgery
Comparison of the inflammatory response between miniaturized and standard CPB circuits in aortic valve surgery
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DOI：
10.1016/j.ejcts.2006.01.053
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发表时间：
2006-05-01
影响因子：
3.4
通讯作者：
Trivin, Francois
中科院分区：
文献类型：
--
作者：
Bical, Olivier M.;Fromes, Yves;Trivin, Francois
目的：全身炎症反应综合征（SIRS）是体外循环（CPB）的并发症之一。最近的发展倾向于使用具有减少的预充体积和更少的血液-空气界面的小型化闭合回路来最小化CPB的生物学影响。这些小型化闭合回路在炎症反应方面的益处已在冠状动脉手术中得到证实。然而，在心脏直视手术中，CPB回路不再是封闭的，小型化装置的益处可能消失。本研究的目的是比较主动脉手术中标准电路和小型电路之间的SIRS。研究方法：40例接受单一主动脉瓣置换术的患者被随机分配到标准CP B组（A组，n = 20）或小型CP B组（B组，n = 20）。收集相关的临床和手术数据。在CPB前、CPB中和CPB后测定血液学参数（白细胞和中性粒细胞计数）和生化参数（C反应蛋白、细胞因子试验）。结果：两组患者的白细胞和中性粒细胞计数均升高，红细胞压积均下降。在两组中，CPB后C-反应蛋白、IL-6、TNF-α、中性粒细胞弹性蛋白酶和IL-10均升高。然而，与标准CPB（265 +/- 120 ng/ml，P = 0.01和18 +/- 7 pg/ml，P = 0.03）相比，小型CPB脱机后弹性蛋白酶和TNF-α的升高显著较低（分别为116 +/- 46 ng/ml和10 +/- 4 pg/ml）。与标准回路（51 +/- 26，P = 0.004）相比，小型化回路（15 +/- 6 pg/ml）的IL-10升高也较低。结论：本研究表明，在主动脉手术中，与标准CPB相比，小型CPB的炎症反应更少。然而，CPB后总是存在一些炎症，并且在心内直视手术中仍然存在小的生物反应性自由灌注回路。(c)，2006 Elsevier B. V.保留所有权利。
Objective: One of the complications of CPB is the systemic inflammatory response syndrome (SIRS). Recent developments tend to minimize the biological impact of CPB in using miniaturized closed circuit with reduced priming volume and less blood-air interface. The benefit of these miniaturized closed circuits in terms of inflammatory response has been proved in coronary surgery. However, in open heart surgery, the CPB circuit is no more closed and the benefit of the miniaturized set-up could disappear. The aim of the study is to compare the SIRS between standard and miniaturized circuits in aortic surgery. Methods: Forty patients who underwent singular aortic valve replacement were randomly assigned either to a standard CPB (group A, n = 20) or to a miniaturized CPB (group B, n = 20). Pertinent clinical and surgical data were collected. Hematological parameters (leukocyte and neutrophil counts) and biochemical parameters (C-reactive protein, cytokine tests) were determined pre-, on and post-CPB. Results: There were an increase in leukocyte and neutrophil counts and a decline in hematocrit in both groups. In both groups, there was a raise after CPB, in C-reactive protein, IL-6, TNF-alpha, neutrophil elastase, and IL-10. However, the raises of elastase and TNF-alpha were significantly lower after the weaning of miniaturized CPB (116 +/- 46 ng/ml and 10 +/- 4 pg/ml, respectively) compared to standard CPB (265 +/- 120 ng/ml, P = 0.01 and 18 +/- 7 pg/ml, P = 0.03). The raise of IL-10 is also lower with miniaturized circuit (15 +/- 6 pg/ml) compared to standard circuit (51 +/- 26, P = 0.004). Conclusions: This study demonstrates in aortic surgery, the lesser inflammatory response of a miniaturized CPB compared to a standard CPB. However, there is always some inflammation after CPB and a small bio-reactive free perfusion circuit is still to be found in open heart surgery. (c), 2006 Elsevier B.V. All rights reserved.